What is the recommended management for a non-displaced 5th metacarpal fracture?

Management of Non-Displaced 5th Metacarpal Fracture

Non-displaced 5th metacarpal fractures should be managed conservatively with functional treatment using buddy taping or a removable splint, avoiding rigid cast immobilization to allow early mobilization and faster functional recovery. 1, 2

Initial Assessment

• Obtain 3-view radiographs of the hand (posteroanterior, lateral, and 45° semipronated oblique) to confirm the fracture is truly non-displaced and assess for any rotation or angulation 3
• Verify absence of malrotation by examining finger cascade alignment when making a fist 1, 4
• Confirm the fracture is closed without neurovascular injury 1

Conservative Management Criteria

Non-operative treatment is appropriate when the fracture meets all of the following:

• Closed fracture without skin compromise 1, 5
• No malrotation of the digit 1, 4
• Angulation less than 30-70 degrees (most evidence supports up to 70 degrees as acceptable) 1, 5
• Shortening less than 5mm 5
• No joint involvement or displacement 5

Recommended Treatment Protocol

Functional taping is superior to cast immobilization for non-displaced 5th metacarpal fractures, resulting in significantly earlier functional recovery with equivalent anatomical outcomes 2

• Buddy taping with a Futura splint provides the best functional results for stable, non-displaced fractures 1
• If using a splint, position in the "safe position": metacarpophalangeal joint flexed 60-90 degrees with full finger extension 5
• Avoid rigid plaster cast immobilization as it delays functional recovery compared to functional taping 2

Mobilization and Follow-up

• Begin early range of motion exercises once soft tissue swelling subsides (typically within 1 week) 5, 2
• Follow-up radiographs at 1 week and 4 weeks to monitor fracture alignment 2
• Most patients achieve full functional recovery by 3-6 months with functional taping 2

Common Pitfalls to Avoid

• Do not routinely reduce non-displaced fractures - reduction attempts in already-aligned fractures may lead to loss of position 2
• Avoid prolonged rigid immobilization - this delays return to function without improving outcomes 2, 6
• Always check for malrotation clinically - radiographs may miss rotational deformity that causes functional impairment 1, 4

Indications for Surgical Referral

Operative management with K-wire fixation or other methods should be considered if 1, 5:

• Open fracture 1, 5
• Malrotation present 1
• Angulation exceeds 70 degrees 1
• Multiple metacarpal fractures 1
• Neurovascular injury 1
• Significant comminution 1